The black health disadvantage remains a pressing public health issue in the U.S. According to the recent DHHS 'Black and Minority Health Report', 65,000 excess deaths occur each year among blacks when compared to the mortality experience of whites. Cardiovascular (CV) diseases make by far the largest contribution to this loss of life, accounting for over 30% of the excess. Despite improvements in CV mortality for all 4 major sex-race groups during the 1970's, the recent trends in heart disease in the U.S. have begun to diverge. A 50% slowing of the decline in coronary mortality occurred among blacks from 1978-1986, compared to whites, and the gap in life expectancy between the races has widened. As noted in the 'Report', despite the widespread recognition of the importance of the problem, our knowledge regarding the causes of these differentials in CV disease remains inadequate. To address this problem, the Report recommends support for 'innovative uses of current data' and 'cross-comparisons from different data sets', emphasizing the unique contribution population-based studies can make to 'understanding the health status and needs of minority populations'. Given the recent deterioration of the black health status relative to the majority population, these recommendations take on new urgency. The investigators in this application have extensive experience in the study of CV diseases among blacks, including clinical research with patient registries and randomized trials, prospective studies, analyses of vital statistics and hospital discharge data, cross-sectional population samples, genetic epidemiology, and cross-cultural studies. This application proposes to utilize national population data sets, prepared by the National Center for Health Statistics, to (1) examine the current black disadvantage in CV health, (2) explore potential clinical and epidemiologic causes, (3) incorporate emerging knowledge of new risk factors and (4) compare trends in medical treatment and risk factors for the 4 sex-race groups. To accomplish these goals we will undertake separate analyses of prevalence surveys, epidemiologic followup studies, hospitalization surveys and vital statistics. These separate analyses will subsequently be combined into a comprehensive description of the clinical and epidemiologic determinants of the black CV disadvantage, and its future trends.